MEDICARE: DR. JULIET L CROSSLAND SORENSEN DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	X0108872	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	IHA8891066	OTHER	NY	INDEPENDENT HEALTH
2	C10887 OI	OTHER	NY	WORKERS COMPENSATION

General Provider Information

NPI Number	:	1215006127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JULIET L CROSSLAND SORENSEN DC

Provider Business Mailing Address
First Line	:	12 WHITING ST
Second Line	:
City	:	NORTH TONAWANDA
State	:	NY
Zip	:	14120-6124
Country	:	US
Telephone Number	:	716-692-4476
Fax Number	:

Provider Business Practice Location Address
First Line	:	12 WHITING ST
Second Line	:
City	:	NORTH TONAWANDA
State	:	NY
Zip	:	14120-6124
Country	:	US
Telephone Number	:	716-692-4476
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	07/08/2007

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